title: Factors related to attrition from VA healthcare use: findings from the National Survey of Women Veterans.
abstract: BACKGROUND
  While prior research characterizes women Veterans' barriers to accessing and using Veterans Health Administration (VA) care, there has been little attention to women who access VA and use services, but then discontinue use. Recent data suggest that among women Veterans, there is a 30 % attrition rate within 3 years of initial VA use.
  
  
  OBJECTIVE
  To compare individual characteristics and perceptions about VA care between women Veteran VA attriters (those who discontinue use) and non-attriters (those who continue use), and to compare recent versus remote attriters.
  
  
  METHODS
  Cross-sectional, population-based 2008-2009 national telephone survey.
  
  
  METHODS
  Six hundred twenty-six attriters and 2,065 non-attriters who responded to the National Survey of Women Veterans.
  
  
  METHODS
  Population weighted demographic, military and health characteristics; perceptions about VA healthcare; length of time since last VA use; among attriters, reasons for no longer using VA care.
  
  
  RESULTS
  Fifty-four percent of the weighted VA ever user population reported that they no longer use VA. Forty-five percent of attrition was within the past ten years. Attriters had better overall health (p = 0.007), higher income (p < 0.001), and were more likely to have health insurance (p < 0.001) compared with non-attriters. Attriters had less positive perceptions of VA than non-attriters, with attriters having lower ratings of VA quality and of gender-specific features of VA care (p < 0.001). Women Veterans who discontinued VA use since 2001 did not differ from those with more remote VA use on most measures of VA perceptions. Overall, among attriters, distance to VA sites of care and having alternate insurance coverage were the most common reasons for discontinuing VA use.
  
  
  CONCLUSIONS
  We found high VA attrition despite recent advances in VA care for women Veterans. Women's attrition from VA could reduce the critical mass of women Veterans in VA and affect current system-wide efforts to provide high-quality care for women Veterans. An understanding of reasons for attrition can inform organizational efforts to re-engage women who have attrited, to retain current users, and potentially to attract new VA patients.
authors.affiliation: VA HSR&D Center of Excellence for Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. alison.hamilton@va.gov
authors.forename: Alison B
authors.initials: AB
authors.lastname: Hamilton
authors.forename: Susan M
authors.initials: SM
authors.lastname: Frayne
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Cordasco
authors.forename: Donna L
authors.initials: DL
authors.lastname: Washington
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006787:Hospitals, Veterans / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data* / Q000639:trends*; D014728:Veterans; D016387:Women's Health / Q000639:trends*; D055815:Young Adult